We May Be Overscreening for Cervical and Breast Cancer in These Women

Although screening for cancer is a helpful strategy for early detection, overscreening can also be a problem. Risks associated with certain cancer screenings may outweigh the benefits among certain patient populations—particularly older adults. According to a study, the rate of overscreening for certain cancers is high, notably for women living in metropolitan areas.

After adults hit a certain age, the U.S. Preventive Services Task Force (USPSTF) discontinues screening recommendations for colorectal, rectum, cervical, and breast cancers. Screening is no longer recommended because data do not support it, the benefits of screening decline due to more serious, noncancer comorbidities that older adults are at risk for, and because screening carries risks of its own.

“Overscreening refers to routine screening of patients older than the recommended upper age limit or with limited life expectancy,” the researchers defined.

For the present study, 176,348 adults were contacted via telephone to complete a survey; patients were excluded from cancer-specific subsample groups if they were previously diagnosed with that cancer. Data were obtained from the 2018 Behavioral Risk Factor Surveillance System. Patients were stratified by geographic location, based on whether they lived in a metropolitan area. The main outcome was overscreening per USPSTF definitions on the upper age limit for the specific cancer: colorectal cancer, 75 years; cervical cancer, 65 years; and breast cancer, 74 years.

Overscreening More Common in Women, Metropolitan Residents

Most of the cohort (88.1%; n=155,411) was female. The mean age was 75.0 years; 85.6% of participants (n=150,871) were white. About a third of the cohort (n=60,456; 34.3%) were metropolitan residents. When looking at cancer-specific subsamples, for colorectal cancer, there were 20,937 (11.9%) men and 34,244 (19.4%) women; for cervical cancer, there were 82,811 (47.0%) women; and for breast cancer, there were 38,356 (21.8%) women.

The overscreening rates were:

  • Colorectal cancer (men): 9,461 (59.3%; 95% confidence interval [CI], 57.6% to 61.1%)
  • Colorectal cancer (women): 14,463 (56.2%; 95% CI, 54.7% to 57.6%)
  • Cervical cancer (women): 31,988 (45.8%; 95% CI, 44.9% to 46.7%)
  • Breast cancer (women): 26,198 (74.1%; 95% CI, 73.0% to 75.3%)

Women living in metropolitan areas were more likely to be overscreened for colorectal cancer (adjusted odds ratio [aOR], 1.23; 95% CI, 1.08 to 1.39), cervical cancer (aOR, 1.20; 95% CI, 1.11 to 1.29), and breast cancer (aOR, 1.36; 95% CI, 1.17 to 1.57). Overscreening was more common among women with a usual source of care, compared to those who did not have one, for cervical cancer (aOR, 1.87; 95% CI, 1.56 to 2.25) and breast cancer (aOR, 2.08; 95% CI, 1.58 to 2.76). Women with good, very good, or excellent self-reported health, compared to those with fair or poor self-reported health, also had higher rates of overscreening for cervical cancer (aOR, 1.21; 95% CI, 1.11 to 1.32) and breast cancer (aOR, 1.47; 95% CI, 1.28 to 1.69). Other factors associated with overscreening for cervical and breast cancers were an educational attainment greater than a high school diploma, compared to a high school diploma or less (aOR, 1.14; 95% CI, 1.06 to 1.23 and aOR, 1.30; 95% CI, 1.16 to 1.46; respectively), and being married or living as married, compared to other marital status (aOR, 1.36; 95% CI, 1.26 to 1.46 and aOR, 1.54; 95% CI, 1.34 to 1.77, respectively).

The study was published in JAMA Network Open.

“Importantly, these patterns [overscreening in older, female metropolitan residents] are not strongly associated with predicted life expectancy. The results of this study can be used by public health, primary care, and health care systems to prevent overscreening. Interventions to reduce overscreening for cancer among older adults are needed to improve preventive care and reduce health care burden, costs, and harms for this population,” the researchers concluded.